Abstract

o annually, with more than a million due to potentially life-threatening strokes. Without prompt diagnosis and treatment, these patients may die or suffer permanent morbidity. Unfortunately, misdiagnosis appears to be frequent. This lecture will emphasize the bedside diagnostic approach to the patient with acute dizziness. The focus will be on rapid and efficient recognition of transient ischemic attacks in those with episodic vestibular symptoms and acute stroke in patients presenting with a severe episode of continuous, prolonged dizziness, vertigo, or imbalance–the “acute vestibular syndrome” (AVS). In patients with AVS, dangerous vertebrobasilar strokes can be distinguished from benign peripheral causes (vestibular neuritis or labyrinthitis) using three specific bedside oculomotor tests (Head Impulse test, Nystagmus, Test of Skew, HINTS). HINTS diagnosis in AVS is more sensitive and cost-effective than early magnetic resonance imaging for detecting stroke.